The potential link between aging and insulin signaling has attracted substantial attention since several decades ago, on the basis of evidence including age-related increase in incidence of insulin resistance, insulin resistance and type 2 diabetes in accelerated aging syndromes and lifespan extention by caloric restriction in rodents. In addition, the intensive investigations in C. elegans in the 1990's, which have identified insulin signaling components including daf-2, age-1 and daf-16 as the genes whose mutations lead to lifespan extention, shed new light on molecular mechanisms underlying aging. As suggested by the genetic studies in C. elegans, it was recently demonstrated that FKHR, FKHRL1 and AFX, which are mammalian homologues of daf-16 forkhead transcription factor, function downstream of insulin signaling and Akt/PKB under cellular conditions. However, it is an open question whether insulin signaling components, including forkhead transcription factors, play a critical role in aging and longevity in mammals as well as in C. elegans. Increasing evidence concerning C. elegans indicates that augmented resistance to stress, in particular, that to oxidative stress is involved in lifespan extention by genetic mutations of insulin signaling components. The intriguig finding that signals from the reproductive system regulate lifespan by modulating the activities of insulin signal transduction pathway in C. elegans suggests a possibility of co-evolution of reproduction and aging. The significance of studies on C. elegans with regard to human aging is discussed.
In order to maintain and improve mental health of elderly people living in the community, a cross sectional survey was conducted to elucidate their happiness and background factors. The subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study employed the self-recording questionnaire forms used in Kahoku Longitudinal Aging Study by Matsubayashi et al. Happiness was assessed using a visual analogue scale. Out of 2, 379 elderly persons who were able to fill in the questionnaire by themselves in 2, 361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1, 873 (78.7%) (860 men (average age 72.7 years) and 1, 013 women (average age 72.8 years)). Among those with greater happiness, the ratio of those living with others (p=0.0051) was high, as well as those with spouses (p=0.0240), without a history of hypertension (p=0.0096) and apoplexy (p=0.0039), not receiving medication regularly (p=0.0039), with regular habit of walking (p<0.001), or with work (p<0.001). As for the relationship between happiness and various scores, the higher the happiness scale became, the scores for ADL, information-related function, functional and emotional support network, healthy condition, appetite condition, sleep condition, memory condition, family relationships, friendship, economic condition became significantly higner (p<0.001, respectively). On multiple regression analysis using the background factors for happiness as explanatory variables, factors such as functional support network (p<0.001), emotional support network (p=0.0254), healthy condition (p<0.001), good memory condition (p=0.0027), friendship (p<0.001), good economic condition (p<0.001) were significant independent contributing factors. As for the relation between SDS and happiness, the more serious the SDS score (higher score) became, the scores for the feeling of happiness became significantly smaller (p<0.001). For amelioration of the happiness of elderly persons living in the community, attempts should be made to improve the background factors clarified by the present study by efficiently utilizing health, medical and welfare services.
Sex differences in factors related to subjective well-being were evaluated in people in their late old age by interviewing individuals aged 75 years and over living in 2 regions of Enzan City, Yamanashi Prefecture. The 17-item revised “Philadelphia Geriatric Center (PGC) Morale Scale” was used for evaluation of subjective well-being. Factors related to family status, employment, health related factors, activities of daily living, and results of physical examinations were each classified into two or more categories, and PGC Morale Scale points were compared among the categories for all subjects and separately for males and females using the Mann-Whitney test and the Kruskal-Wallis test. 1) Although the mean age of males (80.0±4.4 years) and females (80.4±4.3 years) was no significantly difference, PGC Morale Scale points were significantly higher in males than in females (p<0.05), indicating a sex difference in subjective well-being. 2) In elderly females, subjective well-being was related to many factors, and there was a particularly strong relationship between subjective well-being and both health related factors and activities of daily living. 3) In elderly males, the factors related to subjective well-being were fewer than in females, consisting only of “social opportunities”, “hobbies”, and “grip strength”. Since factors related to subjective well-being differ between the sexes, these differences must be taken into account when evaluating subjective QOL of the elderly.
The aim of this study was to clarify the relationship between serum leptin concentration and age, gender and body fat distribution. Serum leptin concentrations were determined 267 subjects (138 men and 129 women), aged 30 to 91. The thicknesses of the preperitoneal fat layer (Pmax) and subcutaneous fat layer (Smin) in the abdomen were measured by ultrasonography. Fat mass and percent fat were measured by the bioelectrical impedance analysis method. Women had higher leptin and leptin/fat mass values than men in all BMI groups (BMI<20, 20-23.9, 24-25.9, ≥26). The leptin concentration correlated significantly with BMI, fat mass, percent fat, waist, hip, waist/hip ratio (W/H), Pmax, Smin and serum Cr in both men and women. The leptin concentration correlated significantly with age in men only and P/S in female only. Leptin/fat mass values significantly correlated with age, fat mass, and percent fat, but not with BMI, waist, hip, W/H, Pmax, Smin and P/S in men. In women, leptin/fat mass values significantly correlated with BMI, fat mass, percent fat, waist, hip, Pmax, Smin and P/S, but not with age or W/H. Multiple regression analysis showed that fat mass and serum creatinine were significant determinants of the leptin and leptin/fat mass values both in men and women, but that age was a significant determinant of these values only in men. These results suggest that the influence of aging on serum leptin concentration exists only in men.
A 67-year-old woman was admitted to our hospital with a fever. She had been experiencing arthralgia for about one month. On admission, she had a fever of 38.5°C, was anemic and was experiencing tenderness in the joints of both hands, elbows and feet. Laboratory data revealed proteinuria, urinary cylinders, pancytopenia (WBC 900/mm3, Hb 9.5g/dl, Plt 7.8 ×104/mm3), liver dysfunction (GOT 414IU/l, GPT 140IU/l), and hyper-gamma globulinemia. Antibiotics and granulocyte-colony stimulating factor were administered intravenously. Bone marrow aspiration was unsuccessful, but a bone marrow biopsy revealed bone marrow fibrosis. Immunological examinations were positive for antinuclear antibodies, anti-deoxyribonucleic acid (DNA) antibodies, anti-double stranded anti-DNA antibodies, as well as a decreased level of serum complement and an increased level of serum immune complexes. Tests for viral antigens and antibodies known to cause hepatitis were negative. Based on these findings, a diagnosis of SLE accompanied by liver dysfunction and bone marrow fibrosis was made. Steroid pulse therapy was initiated, but her liver function deteriorated on the first day of steroid therapy, and she died three days later. SLE accompanied by myelofibrosis is extremely rare, and only 17 and cases have been reported to date. Among these reports, the present case is the second oldest subject and the first SLE patient to suffer from both myelofibrosis and severe liver dysfunction.
Sweet's syndrome occurring during the course of interstitial pneumonitis in a 70-year-old woman was encountered. She was admitted because of dyspnea on exercise, dry cough and interstitial shadow on chest x-ray. Lung biopsy, together with other findings confirmed interstitial pneumonitis. Five days after admission, genital ulcer and aphtha on the oral mucosa were detected and exudative erythema appeared on her right shoulder, chest and back. Histological examination of the skin lesions demonstrated numerous nutrophilic infiltration in the upper dermis, indicating Sweet's syndrome. The skin eruption rapidly disappeared on treatment with colchicine. Although six months after admission interstitial pneumonitis caused respiratory failure, treatment with prednisolone and cyclophosphamide was effective. Serological and immunological tests demonstrated hyper-gammaglobulinemia and positive reaction for anti SS-A antibody. Pathological examination of the lip revealed numerous lymphocyte infiltrates around the duct of the minor salivary gland, suggesting Sjögren's syndrome as the background disease of Sweet's syndrome and interstitial pneumonitis. This evidence indicating that even in elderly patients, skin lesions of Sweet's syndrome may reveal the background disease.
It was very difficult to treat a 90-year-old woman for choledocholithiasis with acute obstructive suppurative cholangitis, gallbladder perforation, and a pool of bile in the right perirenal spase. Extracorporeal shockwave lithotripsy (ESWL) was performed after emergency percutaneous transhepatic biliary drainage (PTBD), but we could not perform lithotripsy successfully because of large and hard stones. Although Endoscopic sphincterotomy (EST) was performed using an ultratome by rendezvous method. Lithotripsy was finally successful, after three times endoscopic mechanical lithotripsy (EML) and procedure using an endotriptor for basket impaction. It is very important in advanced aged patients that endoscopic treatment should be performed step by step.
A 67-year-old man with right hemiparesis and dysarthria was admitted with right hemiparesis involving the face, hyperpathia, numbness and pain of the right body and limb except the face, and had hyperreflexia and pathological reflex in the right limb. Brain MRI on the day after admission disclosed no lesion which might explain the symptoms. Short latency somatosensory evoked potential showed a low amplitude after P14 when the right side was stimulated. Cerebral angiography revealed occlusion of the left vertebral artery. Brain MRI on the 18th hospital day disclosed left medial medullary infarction, so we diagnosed medial medullary syndrome. This case was hard to diagnose, because of the atypical features and the absence of an abnormal lesion on the initial MRI.